ABSTRACT
According to the ERC and the AHA guidelines, FiO2 should be titrated to achieve an O2Sat ≥ 94%. The aim of this study was to determine the minimum oxygen flow and time needed to reach an FiO2 of 0.32 and 0.80 during post-cardiac arrest care. An experimental analysis was performed that consisted of a simulated post-cardiac arrest situation. Different resuscitators were tested and connected to an artificial lung: Mark IV, SPUR II, Revivator Res-Q, O-TWO. The oxygen flow levels tested were 2, 5, 10 and 15 lpm. Bonferroni and Mann-Whitney U tests were used. An FiO2 of 0.32 or more was obtained using any of the oxygen flow and resuscitators. Only the Mark IV achieved an FiO2 of 0.80 after a minimum of 75s ventilating with 2 or 5 lpm. Clinical and statistical differences (P<.05) were found: at 15 lpm it took 35s to reach an FiO2 of 0.80 or more for Mark IV (85.6 [0.3]) and Revivator (84.3 [1.5]) compared to 50s for SPUR II (87.1 [6.4]); at 2 lpm, all of the devices reached an FiO2 of ≥ 0.32 at 30s(Mark IV (34.8 [1.3]), Revivator (35.7 [1.5]) and SPUR II (34.4 [2.1]), except for O-TWO, which took 35s (36.3 [4.3]). Patients could be ventilated with any of the resuscitators using 2 lpm to obtain an FiO2 of 0.32, although possibly O-TWO would be the last option during the first 60s. In order to reach an FiO2 of 0.80, ventilating with 10 lpm should be sufficient, and preferably using Mark IV or Revivator Res-Q. In conclusion, on observing the results of our study, in any possible scenario, it would be advisable to use Revivator Res-Q or Mark IV rather than O-TWO or SPUR II.
Subject(s)
Resuscitation , Heart Arrest , Humans , Oxygen , Respiration, Artificial , Ventilators, MechanicalABSTRACT
El aneurisma toracoabdominal requiere de un manejo multidisciplinar debido a su complejidad tanto en la técnica quirúrgica como en el tratamiento anestésico. La complicación postoperatoria más temida es la isquemia medular, que se presenta con una clínica e instauración variable, a su vez que su recuperación puede ser parcial o completa. El manejo postoperatorio de la isquemia medular se basa en medidas que aumentan la perfusión medular, principalmente la optimización hemodinámica y el drenaje de líquido cefalorraquídeo (LCR). Presentamos 2 casos de paraplejía tardía, uno tras reparación abierta de aneurisma aórtico toracoabdominal y otro después del tratamiento endovascular de aneurisma de la aorta torácica descendente, con recuperación completa del déficit neurológico tras drenaje de LCR (AU)
Thoracoabdominal aneurysm requires multidisciplinary management due to its complexity both in surgical technique and anesthetic considerations. One of the most feared postoperative complication is spinal cord ischemia. It can be presented as different clinical patterns, and its recovery may be partial or complete. The postoperative management of spinal cord ischemia is mainly based on techniques to increase spinal cord perfusion, above all, hemodynamic stability and cerebrospinal fluid drainage. We present two cases of delayed paraplegia after an open repair of a thoracoabdominal aneurysm and a descending thoracic aortic aneurysm repair using an endovascular stent graft. They both had a complete neurological recovery after cerebrospinal fluid drainage (AU)
Subject(s)
Humans , Male , Female , Paraplegia/complications , Paraplegia/diagnosis , Paraplegia/drug therapy , Aneurysm/complications , Aneurysm/diagnosis , Postoperative Complications/drug therapy , Hemodynamics , Endovascular Procedures/methods , Endovascular Procedures , Ischemia/complications , Ischemia/diagnosis , Spinal Cord Ischemia/complications , Cerebrospinal FluidABSTRACT
Thoracoabdominal aneurysm requires multidisciplinary management due to its complexity both in surgical technique and anesthetic considerations. One of the most feared postoperative complication is spinal cord ischemia. It can be presented as different clinical patterns, and its recovery may be partial or complete. The postoperative management of spinal cord ischemia is mainly based on techniques to increase spinal cord perfusion, above all, hemodynamic stability and cerebrospinal fluid drainage. We present two cases of delayed paraplegia after an open repair of a thoracoabdominal aneurysm and a descending thoracic aortic aneurysm repair using an endovascular stent graft. They both had a complete neurological recovery after cerebrospinal fluid drainage.
Subject(s)
Aortic Aneurysm, Thoracic/surgery , Paraplegia , Postoperative Complications , Humans , Male , Middle Aged , Paraplegia/diagnosis , Postoperative Complications/diagnosis , Time FactorsABSTRACT
Many recent studies have underlined the importance of quantitative neuromuscular monitoring and the high incidence of residual block in clinical practice in spite of the use of nondepolarizing neuromuscular blockers of intermediate duration. Neuromuscular monitoring facilitates the tailoring of the muscular paralysis and appropriate patient recovery at the end of surgery. Monitoring also controls or prevents residual block and serves to guide the use of reversing agents. This review describes the physiology of neuromuscular junctions as well as the principles and patterns of nerve stimulation and clinical monitoring. In addition to drawing on their own experience, the authors have reviewed the literature available through evidence-based indexes and other databases up to December 2008. Most references found were case series and reviews. Quantitative monitoring is an evidence-based practice that should be applied in all situations in which a neuromuscular block is established.
Subject(s)
Neuromuscular Blockade , Electric Stimulation/methods , Electrodiagnosis/instrumentation , Electrodiagnosis/methods , Evidence-Based Medicine , Humans , Intraoperative Complications/etiology , Intraoperative Complications/prevention & control , Monitoring, Intraoperative , Neuromuscular Blockade/adverse effects , Neuromuscular Blocking Agents/administration & dosage , Neuromuscular Blocking Agents/adverse effects , Neuromuscular Blocking Agents/pharmacology , Neuromuscular Junction/drug effects , Neuromuscular Junction/physiology , Peripheral Nerves/drug effects , Peripheral Nerves/physiology , Practice Guidelines as Topic , Refractory Period, Electrophysiological/physiologySubject(s)
Monitoring, Intraoperative , Neuromuscular Blockade , Electric Stimulation/methods , Electrodiagnosis/instrumentation , Electrodiagnosis/methods , Equipment Design , Evidence-Based Medicine , Humans , Intraoperative Complications/diagnosis , Intraoperative Complications/etiology , Intraoperative Complications/prevention & control , Monitoring, Intraoperative/instrumentation , Monitoring, Intraoperative/methods , Muscle, Skeletal/innervation , Muscle, Skeletal/physiology , Neuromuscular Blockade/adverse effects , Neuromuscular Blocking Agents/administration & dosage , Neuromuscular Blocking Agents/adverse effects , Neuromuscular Blocking Agents/pharmacology , Peripheral Nerves/physiology , Practice Guidelines as TopicABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Neuromuscular Blocking Agents/administration & dosage , Neuromuscular Blocking Agents/metabolism , Neuromuscular Blocking Agents/therapeutic use , Peer Review, Health Care/methods , Anesthesiology/methods , Anesthesiology/statistics & numerical data , Pain/therapy , Evidence-Based Medicine/methods , Societies/organization & administration , Societies/standards , Societies, Medical/organization & administration , Anesthesiology/education , Neuromuscular Agents/adverse effects , Neuromuscular Blocking Agents/adverse effects , Neuromuscular Diseases/chemically inducedSubject(s)
Neuromuscular Blockade/standards , Neuromuscular Blocking Agents/administration & dosage , Algorithms , Atropine/therapeutic use , Contraindications , Critical Care/methods , Critical Care/standards , Delayed Emergence from Anesthesia , Evidence-Based Medicine , Humans , Intubation, Intratracheal , Monitoring, Intraoperative , Neostigmine/therapeutic use , Neuromuscular Blockade/adverse effects , Neuromuscular Blockade/methods , Neuromuscular Blocking Agents/adverse effects , Neuromuscular Blocking Agents/antagonists & inhibitors , Neuromuscular Blocking Agents/classificationABSTRACT
Los autores realizan una revisión y actualización de los dispositivos que a lo largo de los años han permitido la intubación endotraqueal. Junto a modificaciones puramente anecdóticas se han desarrollado innumerables modificaciones de la pala del laringoscopio o de sus articulaciones, algunas de las cuales han supuesto un importante avance en la laringoscopia. Se describen laringoscopios rígidos, fibrolaringoscopios rígidos, fibrolaringoscopia flexible, dispositivos supraglóticos, estiletes fibro-ópticos y accesorios que facilitan la intubación endotraqueal. Se hace mención de todos y cada uno de dichos dispositivos y accesorios, así como de su utilidad y experiencia clínica
The authors have performed a review of the devices that over the years have allowed the intubation of the trachea. Apart from anecdotal modifications, many modifications of the laryngoscopeblade or of its articulations have been developed, many of them have resulted in an important advance in the laryngoscopy. Rigid laringoscopes, rigid fibre optic laryngoscopes, flexible fibre optic intubation, supraglotic devices, fibre optic stylets and accesories are reviewed. Mention is made of all these devices and accesories, as well as their utility and clinical experience
